Salud de los trabajadores

Actividad física y su relación con los factores de riesgo cardiovascular de carteros chilenosAnálisis de resultados: riesgos psicosociales en el trabajo Suceso-Istas 21 en Cesfam QuellónAusentismo laboral por enfermedades oftalmológicas, Chile 2009Brote de diarreas por norovirus, posterremoto-tsunami, Constitución, Región del MauleCalidad de vida en profesionales de la salud pública chilenaCaracterización del reposo laboral en personal del SSMN durante el primer semestre de 2010Concentración de nicotina en pelo en trabajadores no fumadores expuestos a humo de tabaco ambientalCondiciones de trabajo y bienestar/malestar docente en profesores de enseñanza media de SantiagoDisfunción auditiva inducida por exposición a xilenoErgonomía aplicada al estudio del síndrome de dolor lumbar en el trabajoEstimación de la frecuencia de factores de riesgo cardiovascular en trabajadores de una empresa mineraExposición a plaguicidas inhibidores de la acetilcolinesterasa en Colombia, 2006-2009Factores de riesgo y daños de salud en conductores de una empresa peruana de transporte terrestre, 2009Las consecuencias de la cultura en salud y seguridad ocupacional en una empresa mineraPercepción de cambios en la práctica médica y estrategias de afrontamientoPercepción de la calidad de vida en la Universidad del BiobíoPesos máximos aceptables para tareas de levantamiento manual de carga en población laboral femeninaRiesgo coronario en trabajadores mineros según la función de Framingham adaptada para la población chilenaTrastornos emocionales y riesgo cardiovascular en trabajadores de la salu

Clonal chromosomal mosaicism and loss of chromosome Y in elderly men increase vulnerability for SARS-CoV-2

The pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2, COVID-19) had an estimated overall case fatality ratio of 1.38% (pre-vaccination), being 53% higher in males and increasing exponentially with age. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, we found 133 cases (1.42%) with detectable clonal mosaicism for chromosome alterations (mCA) and 226 males (5.08%) with acquired loss of chromosome Y (LOY). Individuals with clonal mosaic events (mCA and/or LOY) showed a 54% increase in the risk of COVID-19 lethality. LOY is associated with transcriptomic biomarkers of immune dysfunction, pro-coagulation activity and cardiovascular risk. Interferon-induced genes involved in the initial immune response to SARS-CoV-2 are also down-regulated in LOY. Thus, mCA and LOY underlie at least part of the sex-biased severity and mortality of COVID-19 in aging patients. Given its potential therapeutic and prognostic relevance, evaluation of clonal mosaicism should be implemented as biomarker of COVID-19 severity in elderly people. Among 9578 individuals diagnosed with COVID-19 in the SCOURGE study, individuals with clonal mosaic events (clonal mosaicism for chromosome alterations and/or loss of chromosome Y) showed an increased risk of COVID-19 lethality

Diseño estratégico de vanguardia

La integración del diseño con la vanguardia se observa natural, esto es, el diseño es una disciplina abductiva y la vanguardia persigue fines prospectivos, es decir, en ambos casos se trata de objetivos de posibilidad futura. De tal suerte, este libro, emanado de una parte de las ponencias rigurosamente arbitradas del Coloquio Internacional de Diseño 2016, está dividido en tres secciones o capítulos, a saber, el capítulo uno relacionado con la teoría y metodología para proyectos de diseño de vanguardia, el segundo sobre la tecnología, la innovación y la sostenibilidad de vanguardia de dichos proyectos, y finalmente el último capítulo, vinculado con la gestión estratégica de proyectos de vanguardia.La historia se forja de hechos e interpretaciones, de pasados construidos y de presentes en procesos constantes, estudiados en forma estricta por las ciencias. Por su parte, el futuro ostenta la posibilidad de ser indefinidamente planeado con base en las variopintas aproximaciones teóricas y empíricas que dan fundamento a este tipo de ciencia; éstas son denominadas prospectivas y sus bases vanguardias. Resulta importante señalar, que estas posibilidades sólo permiten tener una idea hipotética de lo que será la realidad y el mundo de vida de los seres vivos y su contexto, no obstante, se trata de la única manera racional que tiene el ser humano de prever ese futuro posible. Las distintas ciencias y disciplinas nos permiten construir históricamente estas posibilidades partiendo de datos, hechos, significados y un sinfín de informaciones que le dan cuerpo y sentido a tales posibilidades. En este sentido, la vanguardia, como base del conocimiento prospectivo, observa la necesidad de ser escrita, leída y discutida en los términos más estrictos con el fin de volver las predicciones más precisas. El diseño por su parte, es definido de manera sucinta como la disciplina proyectual estratégica y sistémica de la posibilidad, dirigida a procesos de significación utilitaria y simbólica para la comprensión –o interpretación– y modificación –o proyectación– de niveles de realidad (referentes y sujetos) desde diversos aparatos teóricos y empíricos –perspectivas disciplinarias–

New insights into the genetic etiology of Alzheimer's disease and related dementias

Characterization of the genetic landscape of Alzheimer's disease (AD) and related dementias (ADD) provides a unique opportunity for a better understanding of the associated pathophysiological processes. We performed a two-stage genome-wide association study totaling 111,326 clinically diagnosed/'proxy' AD cases and 677,663 controls. We found 75 risk loci, of which 42 were new at the time of analysis. Pathway enrichment analyses confirmed the involvement of amyloid/tau pathways and highlighted microglia implication. Gene prioritization in the new loci identified 31 genes that were suggestive of new genetically associated processes, including the tumor necrosis factor alpha pathway through the linear ubiquitin chain assembly complex. We also built a new genetic risk score associated with the risk of future AD/dementia or progression from mild cognitive impairment to AD/dementia. The improvement in prediction led to a 1.6- to 1.9-fold increase in AD risk from the lowest to the highest decile, in addition to effects of age and the APOE ε4 allele

Dissecting the Shared Genetic Architecture of Suicide Attempt, Psychiatric Disorders, and Known Risk Factors

Background Suicide is a leading cause of death worldwide, and nonfatal suicide attempts, which occur far more frequently, are a major source of disability and social and economic burden. Both have substantial genetic etiology, which is partially shared and partially distinct from that of related psychiatric disorders. Methods We conducted a genome-wide association study (GWAS) of 29,782 suicide attempt (SA) cases and 519,961 controls in the International Suicide Genetics Consortium (ISGC). The GWAS of SA was conditioned on psychiatric disorders using GWAS summary statistics via multitrait-based conditional and joint analysis, to remove genetic effects on SA mediated by psychiatric disorders. We investigated the shared and divergent genetic architectures of SA, psychiatric disorders, and other known risk factors. Results Two loci reached genome-wide significance for SA: the major histocompatibility complex and an intergenic locus on chromosome 7, the latter of which remained associated with SA after conditioning on psychiatric disorders and replicated in an independent cohort from the Million Veteran Program. This locus has been implicated in risk-taking behavior, smoking, and insomnia. SA showed strong genetic correlation with psychiatric disorders, particularly major depression, and also with smoking, pain, risk-taking behavior, sleep disturbances, lower educational attainment, reproductive traits, lower socioeconomic status, and poorer general health. After conditioning on psychiatric disorders, the genetic correlations between SA and psychiatric disorders decreased, whereas those with nonpsychiatric traits remained largely unchanged. Conclusions Our results identify a risk locus that contributes more strongly to SA than other phenotypes and suggest a shared underlying biology between SA and known risk factors that is not mediated by psychiatric disorders.Peer reviewe

Multiancestry analysis of the HLA locus in Alzheimer’s and Parkinson’s diseases uncovers a shared adaptive immune response mediated by HLA-DRB1*04 subtypes

Across multiancestry groups, we analyzed Human Leukocyte Antigen (HLA) associations in over 176,000 individuals with Parkinson’s disease (PD) and Alzheimer’s disease (AD) versus controls. We demonstrate that the two diseases share the same protective association at the HLA locus. HLA-specific fine-mapping showed that hierarchical protective effects of HLA-DRB1*04 subtypes best accounted for the association, strongest with HLA-DRB1*04:04 and HLA-DRB1*04:07, and intermediary with HLA-DRB1*04:01 and HLA-DRB1*04:03. The same signal was associated with decreased neurofibrillary tangles in postmortem brains and was associated with reduced tau levels in cerebrospinal fluid and to a lower extent with increased Aβ42. Protective HLA-DRB1*04 subtypes strongly bound the aggregation-prone tau PHF6 sequence, however only when acetylated at a lysine (K311), a common posttranslational modification central to tau aggregation. An HLA-DRB1*04-mediated adaptive immune response decreases PD and AD risks, potentially by acting against tau, offering the possibility of therapeutic avenues

Genomic investigations of unexplained acute hepatitis in children

Since its first identification in Scotland, over 1,000 cases of unexplained paediatric hepatitis in children have been reported worldwide, including 278 cases in the UK1. Here we report an investigation of 38 cases, 66 age-matched immunocompetent controls and 21 immunocompromised comparator participants, using a combination of genomic, transcriptomic, proteomic and immunohistochemical methods. We detected high levels of adeno-associated virus 2 (AAV2) DNA in the liver, blood, plasma or stool from 27 of 28 cases. We found low levels of adenovirus (HAdV) and human herpesvirus 6B (HHV-6B) in 23 of 31 and 16 of 23, respectively, of the cases tested. By contrast, AAV2 was infrequently detected and at low titre in the blood or the liver from control children with HAdV, even when profoundly immunosuppressed. AAV2, HAdV and HHV-6 phylogeny excluded the emergence of novel strains in cases. Histological analyses of explanted livers showed enrichment for T cells and B lineage cells. Proteomic comparison of liver tissue from cases and healthy controls identified increased expression of HLA class 2, immunoglobulin variable regions and complement proteins. HAdV and AAV2 proteins were not detected in the livers. Instead, we identified AAV2 DNA complexes reflecting both HAdV-mediated and HHV-6B-mediated replication. We hypothesize that high levels of abnormal AAV2 replication products aided by HAdV and, in severe cases, HHV-6B may have triggered immune-mediated hepatic disease in genetically and immunologically predisposed children

Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

Paracoccidioidomicosis ganglionar juvenil: reporte de un caso.

La paracoccidioidomicosis es una micosis sistémica profunda, producida por elhongo dimorfo Paracoccidioides brasiliensis, de carácter progresivo y granulomatoso.Se describen dos presentaciones de la enfermedad: la forma crónica, que ocurretradicionalmente en personas adultas dedicadas a la agricultura, y la forma aguda, subagudao juvenil, que corresponde a tan solo el 3-10% de los casos, caracterizándose por ser mássevera y contar con un peor pronóstico. Se presenta el caso de un paciente masculinode 11 años de edad, quien acude a centro hospitalario por presentar fiebre prolongada yadenopatías cervicales. Las serologías para enfermedad de Chagas, histoplasmosis, HTLV-1 y 2, citomegalovirus y Epstein-Barr resultaron negativas. La tomografía computarizadamuestra un plastrón ganglionar paraaórtico en retroperitoneo, así como ganglios decaracterísticas inflamatorios en ambas regiones prevasculares cervicales. Se decide la tomade biopsia de ganglio intra-abdominal, la cual reportó linfadenitis crónica granulomatosanecrotizante con presencia de estructuras micóticas intra y extracelulares compatiblescon P. brasiliensis. A pesar del resultado de la biopsia, la serología para el agente etiológicoresultó negativa. Se le diagnostica paracoccidioidomicosis ganglionar y se indicaanfotericina B por 14 días e itraconazol, el cual es sustituido debido a reacciones adversaspor trimetoprim-sulfametoxazol. Por mejoría del cuadro es egresado luego de 61 días dehospitalización. Las paracoccidioidomicosis por fuera de la descripción epidemiológicaclásica y en sus formas atípicas representan un verdadero reto para el diagnóstico médico,por lo que se deben tener en cuenta para asegurar un manejo adecuado de estos pacientes

Paracoccidioidomicosis ganglionar juvenil: reporte de un caso.

La paracoccidioidomicosis es una micosis sistémica profunda, producida por elhongo dimorfo Paracoccidioides brasiliensis, de carácter progresivo y granulomatoso.Se describen dos presentaciones de la enfermedad: la forma crónica, que ocurretradicionalmente en personas adultas dedicadas a la agricultura, y la forma aguda, subagudao juvenil, que corresponde a tan solo el 3-10% de los casos, caracterizándose por ser mássevera y contar con un peor pronóstico. Se presenta el caso de un paciente masculinode 11 años de edad, quien acude a centro hospitalario por presentar fiebre prolongada yadenopatías cervicales. Las serologías para enfermedad de Chagas, histoplasmosis, HTLV-1 y 2, citomegalovirus y Epstein-Barr resultaron negativas. La tomografía computarizadamuestra un plastrón ganglionar paraaórtico en retroperitoneo, así como ganglios decaracterísticas inflamatorios en ambas regiones prevasculares cervicales. Se decide la tomade biopsia de ganglio intra-abdominal, la cual reportó linfadenitis crónica granulomatosanecrotizante con presencia de estructuras micóticas intra y extracelulares compatiblescon P. brasiliensis. A pesar del resultado de la biopsia, la serología para el agente etiológicoresultó negativa. Se le diagnostica paracoccidioidomicosis ganglionar y se indicaanfotericina B por 14 días e itraconazol, el cual es sustituido debido a reacciones adversaspor trimetoprim-sulfametoxazol. Por mejoría del cuadro es egresado luego de 61 días dehospitalización. Las paracoccidioidomicosis por fuera de la descripción epidemiológicaclásica y en sus formas atípicas representan un verdadero reto para el diagnóstico médico,por lo que se deben tener en cuenta para asegurar un manejo adecuado de estos pacientes